PUERPERAL SEPSIS & UTI.ppt
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The document discusses puerperal sepsis and urinary tract infections. Puerperal sepsis is defined as an infection of the genital tract occurring after childbirth. Common causes include bacteria like Doderlein bacillus. Risk factors include prolonged rupture of membranes, operative deliveries, and retained placental tissues. Signs include fever, foul-smelling discharge, and pelvic pain. Treatment involves isolation, intravenous antibiotics like cefotaxime and metronidazole, and possible drainage of abscesses. Urinary tract infections in the postpartum period are also discussed, with E. coli being a common cause. Symptoms include fever and painful urination. Diagnosis is by urine culture and
PUERPERAL SEPSIS & UTI.ppt
- 1. PUERPERAL SEPSIS AND URINARY TRACT INFECTION BY: MS. LAMNUNNEM HAOKIP SENIOR TUTOR/LECTURER OBG NURSING SSNSR, SU
- 2. PUERPERIUM Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically with in 6 wks. The key to management of sepsis is early recognition, aggressive resuscitation, antibiotic administration and source control.
- 3. INCIDENCES Worldwide, more than 500 000 women die of complications of pregnancy and childbirth
- 4. PUERPERAL SEPSIS Definition : An infection of the genital tract which occurs as a complication of delivery is termed puerperal sepsis.
- 5. COMMON PUERPERAL INFECTIONS Endometritis Endomyometritis Endoparametritis Combination of theses three is called pelvic cellulitis.
- 6. CAUSATIVE ORGANISM Doderlein bacillus (60-70%) Yeast like fungus –candida albicans (25%) Staphylococcus albus or aureus Streptococcus –anerobic common Beta hemolyticus streptococcus rare E.coli
- 7. PREDISPOSING FACTORS Antepartum factors : • Malnutrition and anaemia • Preterm labor • Premature rupture of the membrane • Chronic deliberating illness • Prolonged rupture of the membrane
- 8. • Repeated vaginal examination • Prolonged rupture of the membranes • Dehydration and keto-acidosis during labor • Traumatic operative delivery • Haemorrhage - antepartum or postpartum • Retained bits of the placental tissue or membranes • Placental praevia – placental site lying close to the vagina • Caesarean delivery Intrapartum factors
- 9. PATHOGENESIS • Transmitted by another person • Source - midwife, doctor and other patients or visitors EXOGENOUS • Causative organisms - Streptococcus fecalis • Anaerobic streptococci and clostridium welchi found in the vagina ENDOGENOUS
- 10. SIGN AND SYMPTOMS Local infection- Slight raise in temperature, generalized malaise and headache. Redness and the swelling of the local wound Pus formation and disruption of wound Uterine infection- mild infection Pyrexia of variable degree and tachycardia. Red, copious, offensive lochia & tender and soft uterus.
- 11. CONT… Fever which occurs within 24 hours or more is the first sign. Increased Pulse rate . The uterus is sub-involuted,. Foul smelling vaginal discharge. Local pain and swelling of the infected suture line. Headache, insomnia and anorexia
- 12. In severe sepsis: Constant pelvic pain. Rise in temperature with increased pulse rate. Lower abdominal pain. Intense pain which worsens the condition of the patients. Severe infection of the fallopian tubules. Collection of pus in the pouch of Douglas.
- 13. ⚫Bacteriological study- Smear Culture and antibiotic sensitivity of purulent material High vaginal and cervical swabs Peritoneal fluids Blood culture INVESTIGATIONS
- 14. Urine :- Routine and microscopic examination Culture if infection is suspected CBC Profile
- 15. Ultrasonography- For diagnosis of pelvic masses Pelvic abscess Pelvic peritonitis Retained bits of placenta and/ or membrane Other: X-Ray
- 17. ANTENATAL Improvement of general condition Treatment of septic cocci Abstinence from sexual intercourse in the last two months Care about personal hygiene – bathing in dirty water to be avoided Avoiding contact with people having infection, such as cold, boils. Avoiding unnecessary vaginal examinations and douches in the later months.
- 18. INTRAPARTUM Staff attending on labor client should be free of infections. Full surgical asepsis to be taken while conducting delivery Prophylactic antibiotic must be administered in cases of caesarean section to reduced the incidence of wound infection, endometritis UTI. Ceftriaxone 1g IV immediately after cord clamping and a second dose after 8 hours is recommended.
- 19. POSTPARTUM Take aseptic precautions while dressing the perineal wound Restriction of the visitor in the postpartum ward Mothers to be instructed to use sterile sanitary pads and to change them frequently Vulva and perineum to be cleaned with mild antiseptic solution following urination and defecation Infected mothers and babies are to be isolated
- 20. TREATMENT 1. ISOLATION OF PATIENT: specially when haemolytic streptococcus is obtained on culture. 2. MAINTAIN INTAKE & OUTPUT 3. INDWELLING CATHETER: to relieve any urine retention due to pelvic abscess. 4. ANTIBIOTIC: intravenous administration of cefotaxim 1g, 8hrly & metronidazole 0.5g, every 8 hrly. The treatment is continued for at least 7-10 days.
- 21. SURGICAL INTERVENTION PERINEAL WOUND: • The stitches of the perineal wound may have to be removed to facilitate drainage of pus and relieve pain After the infection is controlled, secondary sutures may be given later. RETAINED UTERINE PRODUCTS PELVIC ABSCESS :should be drained by colpotomy under ultrasound guidance. HYSTRECTOMY
- 23. DEFINITION It is an infection of the urinary organs such as kidney, ureter, urinary bladder and urethra. The causative organisms are: ⚫ E. coli ⚫ Klebsiella ⚫ Proteus ⚫ Staphylococcus aureus
- 24. Others: ⚫Recurrence of previous cystitis and pyelitis ⚫Infection contracted for the first time during pregnancy is due to :- Effect of frequent catheterization either during labor or in early puerperium to relative retention of urine. Stasis of urine during early puerperium due to lack of bladder tone and less desire to pass urine.
- 25. CLINICAL FEATURES Raised temperature ( pyrexia) Costovertebral angle pain Supra pubic discomfort Frequent and often painful micturition Nausea and vomiting
- 26. DIAGNOSIS UTI is confirmed by examination of an uncontaminated midstream clean catch sample for urinalysis and culture and antibiotic sensitivity test.
- 27. MANAGEMENT Adequate intake of fluids Adequate drainage of urine Keeping the perineal area clean and hygienic Frequent changing of inner wears Used of clean warm water Proper Antimicrobial therapy: Ceftriaxone 250 mg 6 hours apart or 500 mg 8 hours apart IV.
- 28. BIBLIOGRAPHY/REFERENCES • Annamma Jabob. A comprehensive textbook of Midwifery and Gynaecological Nursing, Fourth edition. • Lily Podder. Fundamentals of Midwifery and Obstetrical Nursing. ELSEVIER. • DC Dutta’s textbook of Obstetrics. Hiralal Konar 8th Edition.Jaypee The Health Sciences Publisher. • https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/puerperal-sepsis • https://pubmed.ncbi.nlm.nih.gov/23993724/